Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 0-12-4998 BCABA | CA |
NPI | 1013272426 |
---|---|
Provider Name | Jennifer Lopez |
First Address | San Diego, CA 92108 |
Second Address | San Diego, CA 92108-4355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2012 |
Last Update Date | 11/07/2012 |